NOTE: YOU MUST TAB THROUGH THE FORM TO MOVE FROM FIELD TO FIELD
AND FOR THE FORM TO ADD AMOUNTS AUTOMATICALLY.

 
Date:
Company Name:
City:
State:
Name (Principal):
Guest Name:
Guest Name:
Guest Name:

2008 Special Functions
# Attending
# Attending

Thursday Hospitality Reception
8:00 pm -10:00 pm September 11
Friday Member/Vendor Dinner
7:00 pm -til September 12

Friday Night Cocktail Reception
6:00 pm - 7:00 pm September 12
Saturday Member/Vendor Dinner
7:30 pm - 9:30 pm September 13

Registration Fee
By July 30
(early discount)
After July 30
#Attending
1st PremierDPH Member
$500.00
$550.00
x
1
= $ 550.00
Additional Member (2nd or more)
$450.00
$500.00 each
x
= $
Guest/Spouse (Not in DPH Industry)
$350.00
$350.00 each
x
= $

Registration Payment

Sent check - Payable to: Buying Group Services
Total Amount Due $
Charge My Credit Card VISA
Account Number: Expiration Date:
Name on Card:    
Billing Address:
City: State:
Zip:
Send registrations with payment to: BGS Accounting, Post Office Box 4100, New Orleans, LA 70178
or FAX TO: Lesley Hardin @ 504-486-5273.
Cancellation Policy
Cancellations must be made in writing (fax to 504-486-5273) and received by August 14, 2008. No refunds after August 14, 2008. Hotel reservations must be cancelled in accordance with the Arizona Grand Resort policy.

Hotel Reservations

Make your reservations with Arizona Grand Resort
Tel: 877-800-4888 or 602-438-9000
Website: www.PremierDPH.com
Room Rate: Suites available as low as $189.00. Please check PremierDPH website for all available rates.
Promo Code: Premier
Hotel Cut off Date: August 14, 2008 5:00 pm  

Special Needs and/or Dietary Restrictions:
Name:
ADA Requirements:
Name:

Note: Registration fees include all conference sessions, materials, and scheduled meal functions.

BEFORE YOU CLICK SUBMIT, PLEASE PRINT A COPY FOR YOUR RECORDS. IF YOU DO NOT RECEIVE CONFIRMATION WITHIN 5 DAYS, PLEASE CALL ANNIE AT 504-486-5173.